De Ritis Ratio (AST/ALT) as a Significant Prognostic Factor in Patients With Upper Tract Urothelial Cancer Treated With Surgery

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Abstract

Micro-Abstract

We investigated the prognostic significance of De Ritis ratio (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) in patients with upper tract urothelial cancer (UTUC) after surgical treatment. After retrospective analysis of 623 subjects, the elevated AST/ALT levels showed worse survival outcomes and independently predicted postoperative survival outcomes. The AST/ALT can be a useful biomarker for prediction of postoperative prognosis in patients with localized UTUC.

Introduction:

We investigated the clinical prognostic value of preoperative De Ritis ratio (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) on postsurgical survival outcomes in patients with upper tract urothelial cancer (UTUC).

Patients and Methods:

We retrospectively analyzed the data of 623 patients who underwent radical nephrouretectomy for UTUC. Multivariate regression tests were performed to identify possible associations between adverse pathologic events and AST/ALT. The risk of postoperative progression and survival were tested using Kaplan–Meier analyses and Cox proportional hazards models.

Results:

According to the receiver operator characteristic curve of AST/ALT for cancer-specific mortality, patients with AST/ALT value ≥1.5 were regarded as the high AST/ALT group, and the remaining patients formed the low AST/ALT group. In Kaplan–Meier analyses, the high AST/ALT group showed worse progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (all P < .001). Elevated AST/ALT was associated with higher T stage (hazard ratio [HR], 1.577; 95% confidence interval [CI], 1.077-2.311; P = .033) and higher cellular grade (HR, 1.538; 95% CI, 1.034-2.287; P = .041) in multivariate regression tests. In multivariate Cox analyses, high AST/ALT was revealed as an independent predictor of PFS (HR, 2.335; 95% CI, 1.633-3.340; P < .001), CSS (HR, 2.550; 1.689-3.851; P < .001), and overall survival (HR, 2.069; 95% CI, 1.409-3.038; P < .001).

Conclusion:

Elevated preoperative AST/ALT was a significant predictor of worse postoperative survival in patients surgically treated for UTUC. Further large prospective studies are needed for better understanding of the prognostic value of preoperative AST/ALT.

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